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The role of splenectomy in HIV-infected patients with relapsing visceral leishmaniasis

Published online by Cambridge University Press:  11 December 2006

J. TROYA*
Affiliation:
Division of Infectious Diseases, Fundación Jiménez Díaz-UTE, Universidad Autónoma de Madrid, Avda. de Reyes Católicos 2, 28040 Madrid, Spain
A. CASQUERO
Affiliation:
Division of Infectious Diseases, Fundación Jiménez Díaz-UTE, Universidad Autónoma de Madrid, Avda. de Reyes Católicos 2, 28040 Madrid, Spain
G. MUÑIZ
Affiliation:
Servicio de Medicina Interna, Hospital General de Toledo, Av Barber 30, 45004 Toledo, Spain
M. L. FERNÁNDEZ-GUERRERO
Affiliation:
Division of Infectious Diseases, Fundación Jiménez Díaz-UTE, Universidad Autónoma de Madrid, Avda. de Reyes Católicos 2, 28040 Madrid, Spain
M. GÓRGOLAS
Affiliation:
Division of Infectious Diseases, Fundación Jiménez Díaz-UTE, Universidad Autónoma de Madrid, Avda. de Reyes Católicos 2, 28040 Madrid, Spain
*
*Corresponding author: Division of Infectious Diseases, Fundación Jiménez Díaz-UTE, Universidad Autónoma de Madrid, Avda. de Reyes Católicos 2, 28040 Madrid, Spain. Tel: +34656803796. E-mail: [email protected]

Summary

The treatment of visceral leishmaniasis (VL) in HIV-infected patients is characterized by having a protracted course and frequent relapses, despite the use of adequate anti-leishmanial drugs and effective anti-retroviral therapy. A small subset of patients with significant splenomegaly develops severe cytopaenias and chronic leishmania infection. The use of elective splenectomy is effective for restoring the haematological parameters and reduces the need for blood transfusions but it does not avoid relapsing visceral leishmaniasis.

Type
Research Article
Copyright
Copyright © Cambridge University Press 2006

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References

Alvar, J., Cañavate, C., Gutiérrez-Solar Jiménez, M., Laguna, F., López-Vélez, R., Molina, R. and Moreno, J. (1997). Leishmania and human immunodeficiency virus coinfection: the first 10 years. Clinical Microbiology Reviews 10, 298319.CrossRefGoogle ScholarPubMed
Berman, J. (2003). Current treatment approaches to leishmaniasis. Current Opinion in Infectious Diseases 16, 397401.CrossRefGoogle ScholarPubMed
Bernard, N. F., Chernoff, D. N. and Tsoukas, C. M. (1998). Effect of splenectomy on T-cell subsets and plasma HIV viral titres in HIV-infected patients. Journal of Human Virology 1, 338345.Google ScholarPubMed
Centers for Disease Control and Prevention (1992). Classification system for HIV infection and expanded surveillance case definition for AIDs among adolescents and adults. CDC. 41 (RR-17).Google Scholar
Corti, M. E., Villafane, M. F., Suarez Anzorena, F., Daruich, J., Perez Bianco, R., Candela, M., Ferraina, P. and Tezanos Pinto, M. (2003). Splenic artery embolization for the treatment of hypersplenism in hemophilic, HIV-1 and HCV seropositive patients. Medicina (Buenos Aires) 63, 224226.Google ScholarPubMed
Croft, S. L. (2001). Monitoring drug resistance in Leishmaniasis. Tropical Medicine and International Health 6, 899905.CrossRefGoogle ScholarPubMed
Das, A. and Sen Gupta, P. C. (1950). Relapse of Kala-Azar after splenectomy. Lancet 2, 681682.CrossRefGoogle ScholarPubMed
Desjeux, P. and Alvar, J. (2003). Leishmania/HIV co-infections: epidemiology in Europe. Annals of Tropical Medicine and Parasitology 97, 315.CrossRefGoogle ScholarPubMed
George, J. N., Woolf, S. H., Raskob, G. E., Wasser, J. S., Aledort, L. M., Ballen, P. J., Blanchette, V. S., Bussel, J. B., Cines, D. B., Kelton, J. G., Lichtin, A. E., McMillan, R., Okerbloom, J. A., Regan, D. H. and Warrier, I. (1996). Idiopathic thrombocytopenic purpura: a practice guideline developed by explicit methods for the American Society of Hematology. Blood 88, 340.CrossRefGoogle ScholarPubMed
Górgolas, M. and Miles, M. A. (1994). Visceral leishmaniasis and AIDS. Nature, London 372, 734.CrossRefGoogle ScholarPubMed
Jha, T. K., Sundar, S., Thakur, C. P., Bachmann, P., Karbwang, J., Fischer, C., Voss, A. and Berman, J. (1999). Miltefosine, an oral agent for the treatment of Indian visceral leishmaniasis. New England Journal of Medicine 341, 17951800.CrossRefGoogle ScholarPubMed
López Vélez, R., Pérez Molina, J. A., Guerrero, A., Baquero, F., Villarrubia, J., Escribano, L., Bellas, C., Pérez-Corral, F. and Alvar, J. (1998). Clinic-epidemiological characteristics, prognostic factors, and survival analysis of patients co-infected with human immunodeficiency virus and Leishmania in an area of Madrid, Spain. American Journal of Tropical Medicine and Hygiene 58, 436443.CrossRefGoogle Scholar
Lyngdoh, E., Jain, S. C. and Barua, P. (1971). Splenectomy in treatment of drug-resistant Kala-azar. Journal of the Indian Medical Association 57, 458461.Google ScholarPubMed
Rosenthal, E., Marty, P., Poizot Martin, I., Reynes, J., Pratlong, F., Lafeuillade, A., Jaubert, D., Boulat, O., Dereure, J. and Gambarelli, F. (1995). Visceral leishmaniasis and HIV-1 co-infection in southern France. Transactions of the Royal Society of Tropical Medicine and Hygiene 89, 159162.CrossRefGoogle ScholarPubMed
Russo, R., Nigro, L. and Panarello, G. (2003). Clinical survey of leishmania/HIV co-infection in Catania, Italy: the impact of highly active antiretroviral therapy (HAART). Annals of Tropical Medicine and Parasitology 97, 149155.CrossRefGoogle ScholarPubMed
Sundar, S., Jha, T. K., Thakur, C. P., Engel, J., Sindermann, H., Fischer, C., Junge, K., Bryceson, A. and Berman, J. (2002). Oral miltefosine for Indian visceral leishmaniasis. New England Journal of Medicine 347, 17391746.CrossRefGoogle ScholarPubMed
World Health Organization (2000). Leishmania/HIV co-infection in south-western Europe 1990–1998; Retrospective analysis of 965 cases. WHO Technical Report Series No. 2000.42. World Health Organization, Geneva.Google Scholar
World Health Organization/Panamerican Health Organization (2006). Consulta de expertos OPS/OMS sobre leishmaniasis visceral en las américas. PANAFTOSA OPS/OMS. Río de Janeiro (Brasil).Google Scholar